Provider Demographics
NPI:1871071423
Name:CHASTITY J. PIMENTAL LCSW, PLLC
Entity type:Organization
Organization Name:CHASTITY J. PIMENTAL LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:CHASTITY
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:PIMENTAL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-336-8148
Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-0968
Mailing Address - Country:US
Mailing Address - Phone:860-336-8148
Mailing Address - Fax:
Practice Address - Street 1:1153 MAIN ST
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:CT
Practice Address - Zip Code:06238
Practice Address - Country:US
Practice Address - Phone:860-336-8148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-04
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0051341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty